Leprosy
Mailing List, June 22nd, 2009
Ref.:
Clinical case
From:
Ariyawansa D., Thalapathpitiya,
Nugegoda
,
Sri Lanka
Dear
Dr Noto,
I
would like to present a case to LML members for their opinion.
18
year old female was treated for a single patch, histologically
proven tuberculoid leprosy, with paucibacillary treatment according
to WHO guidelines (Rifampicin-monthly, Dapsone-daily).
Pre Treatment Full blood count, Liver funtions and G6PD levels
were normal.
Presented
with high remittent fever (101-
103 F
) and jaundice 3weeks after commencement of anti-leprosy
treatment
with evidence of deep jaundice and hepato-splenomegaly on examination.
Investigations
*WBC/DC(10x
3 / UL)
Total 5.3---8.3--8.6---13.5---16.8---19.07---27
(with Neutrophil leucocytosis and mild eosinophilia)
Haemoglobin
(g/dl)- 8.37--8.9---7.7--8.1----8.6.
Platelet
count-with in normal range
Retic
count-5%---10%
ESR
(mm/1st hour) 20--40--32
Blood
Picture-suggests intra vascular Hemolysis with a left shift
(?underling infective origin)
S.
Bilirubin(mg/dl)
Total
8.1 10.6 16.6
19.2
Direct
6.9 8.6 14.2
15.8
Indirect
1.2 1.8 2.4
3.4
Serum
Alkaline Phosphatase (U/L)-395 587
761
SGOT-
472 370 551 266
SGPT-
419 401 545 442
Hepatitis
Screening ( A,B,C)- Negative
Urine
for Hemosiderin-Negative
CRP-
12 mg/dl
Mycoplasma
AB-Negative
S.
Creatinine 31 Mmol/L
Urine
full report-Few granular casts
Monospot
test-Negative
Widal
Test-Negative
APTT
and Thrombin Test-with in normal range
USS
abdomen-Hepato-splenomegaly with thickened wall of Gall bladder, no
evidence of Gall bladder calculi or liver abscesses.
Management
Discontinued
anti Leprosy treatment
Broad
Spectrum antibiotics
Monitor
vital parameters
Still
being managed as a inward patient
My
question is:-
Can
we explain this picture with Anti Leprosy drugs alone or is it a
double pathology?
Thanking
you,
Dr
Dananja Ariyawansa
Sri
Jayawardenepura
General
Hospital
Thalapathpitiya
Nugegoda
Sri
Lanka
